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Tadalafil is PDE5 inhibitor marketed in pill form for treating erectile dysfunction (ED) under the name Cialis, and under the name

Adcirca for the treatment of pulmonary arterial hypertension. In October 2011 the U.S. Food and Drug Administration (FDA) approved Cialis for treating the signs and symptoms of benign prostatic hyperplasia (BPH) as well as Spherical cells trapped air travel.

a combination of BPH and erectile dysfunction (ED) when the conditions coincide. It initially was developed by the biotechnology company ICOS, and then again developed and marketed world-wide by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company. Cialis tablets, in 2.5В mg, 5В mg, 10В mg, and 20В mg doses, are yellow, film-coated, and almond-shaped. The approved dose for pulmonary arterial hypertension is 40В mg (two 20-mg tablets) once daily.

Tadalafil is also manufactured and sold under the name of Tadacip by the Indian pharmaceutical company Cipla in doses of 10В mg and 20В mg.
On November 21, 2003 the FDA approved tadalafil (as Cialis) for sale in the United States as the third ED prescription drug pill (after sildenafil citrate (Viagra) and vardenafil Hydrochloride (Levitra)). Like sildenafil and vardenafil, tadalafil is recommended as an 'as needed' medication. Cialis is the only one of the three that is also offered as a once-daily medication.

Moreover, tadalafil was approved in May 2009 in the United States for the treatment of pulmonary arterial hypertension
and is under regulatory review in other regions for this condition. In late November 2008, Eli Lilly sold the exclusive

Tadalafil has been used in approximately 15,000 men participating in clinical trials, and over eight million men worldwide (primarily

in the post-approval/post-marketing setting). The most common side Buy Cialiseffects when using tadalafil are headache, stomach discomfort or pain, indigestion, burping, acid reflux, back pain, muscle aches, flushing, and stuffy or runny nose.

These side effects reflect Buy Cialis the ability of PDE5 inhibition to cause vasodilation (cause blood vessels to widen), and usually go away after a few hours. Back pain and muscle aches can occur 12 to 24 hours after taking the drug, and the symptom usually disappears after 48 hours.

In May 2005, Buy Cialisthe U.S. Food and Drug Administration found that tadalafil (along with other PDE5 inhibitors) was associated with vision impairment related to NAION ( nonarteritic anterior ischemic optic neuropathy) in certain patients taking these

drugs in the post-marketing (outside of clinical trials) setting.

Most, but not all, of these patients had underlying anatomic or vascular risk factors for development of NAION unrelated to PDE5 use, including: low cup to disc ratio (crowded disc), age over 50, diabetes, hypertension, coronary artery disease,

hyperlipidemia and smoking. Given the small number of NAION events with PDE5 use (fewer than one in one million), the

large number of users of PDE5 inhibitors (millions) and the fact that this event occurs in a similar population to those who do not take these medicines, the FDA concluded Buy Cialisthat they were not able to draw a cause and effect relationship, given these patients underlying vascular risk factors or anatomical Buy Cialisdefects. However, the label of all three PDE5 inhibitors was changed to alert clinicians to a possible association.
In October 2007, the FDA

announced that the labeling for all PDE5 inhibitors, including tadalafil, requires a more prominent warning of the potential risk of sudden hearing loss as the result of postmarketing reports of deafness associated with use of PDE5 inhibitors.
[2 ] Drug interactions [ edit ]

should not be taken for at least 48 hours after taking the last dose of tadalafil. Using organic nitrites (such as the sex drug amyl nitrite) within this timeframe may increase the risk of life-threatening hypotension.
Since people who

have taken tadalafil within the past 48 hours cannot take organic nitrates to relieve angina (such as glyceryl trinitrate spray), these patients should seek immediate medical attention if they experience anginal chest pain.
[3 ] In the event

of a medical emergency, paramedics and medical personnel should be notified of any recent doses of tadalafil.
Tadalafil is metabolized Buy Cialis predominantly by the hepatic CYP3A4 enzyme system. The presence of other drugs which induce this system can shorten tadalafil half-life and reduce serum levels, and hence efficacy, of the drug. Pharmacodynamics

This section does not cite any references or Buy Cialis sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2011)

resulting in longer duration of action,
Buy Cialis
and so partly responsible for The Weekend Pill sobriquet. Furthermore, the longer half-life is the
Buy Cialis
basis for current investigation of tadalafil's daily therapeutic use in relieving pulmonary arterial hypertension. Sildenafil is approved in several world regions as a thrice-daily therapy for pulmonary arterial hypertension.
Penile erection during sexual stimulation is

caused by increased penile blood

flow resulting from the relaxation of penile arteries and the smooth Buy Cialis muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of Cyclic guanosine monophosphate (more commonly known as Cyclic GMP or cGMP) in smooth muscle cells. cGMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.
The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile

function by increasing the amount of cGMP. Tadalafil (and sildenafil and vardenafil) inhibits PDE5. However, because sexual stimulation is required to initiate the local penile release of nitric oxide, tadalafil's inhibition of PDE5 will have no effect without direct sexual stimulation of the penis. The recommended tadalafil starting dose for most men is 10В mg, taken as needed before sexual activity (but not more than once daily). The dose may be increased to 20В mg or decreased to 5В mg, per its efficacy and the man's personal tolerance of the drug. In June 2007

the European Commission approved low-dose (2.5В mg and 5В mg) Cialis to be used as single-daily ED therapy.
Although available since 2003 in 5, 10, 20В mg dosage, in late 2008/early 2009, the U.S. FDA approved the commercial sale of Cialis in 2.5В mg dosage as a one-a-day treatment for ED. The 2.5В mg dose avoids earlier dispensing restrictions on higher dosages. The price of the 5В mg and 2.5В mg are often similar, so some people score and split the pill.